Construction of physiological anxiety beyond individual pathology: integrating psychophysiological biomarkers and socio-digital contexts among university students in a post-pandemic world

As digital platforms increasingly mediate mental health care, a critical gap persists in understanding how digital engagement and social connectedness influence physiological anxiety, especially in contexts marked by structural inequality, cultural hierarchies and digital saturation, such as Pakistan. This study investigates how active versus passive social media use, combined with perceived social connectedness, affects heart rate variability (HRV), a physiological marker of stress, among university students. Using a biopsychosocial and political economy framework, we conducted real-time HRV monitoring during cognitive stress tasks via a mobile-based system. Results indicate that passive media use in low-connectedness settings is associated with significantly lower HRV, reflecting heightened physiological anxiety, whereas active use in socially embedded contexts predicts higher HRV and better autonomic regulation. These findings show that the emotional and physiological impacts of digital engagement are stratified by relational and sociotechnical factors. HRV emerges as a meaningful biomarker of anxiety when situated within broader social and digital ecologies. While empirically grounded in Pakistan, the findings reflect structural patterns across the Global South, where similar platform logics, infrastructural precarity, and sociocultural hierarchies shape digital mental health risks. The study contributes to critical public health by underscoring the need for equity-driven, context-sensitive digital mental health strategies.